Inguinal Hernias: Diagnosis and Management
KIM EDWARD LeBLANC, MD, PhD; LEANNE L. LeBLANC, MD; and KARL A. LeBLANC, MD, MBA ,Louisiana State University School of Medicine, New Orleans, Louisiana
Am Fam Physician. 2013 Jun 15;87(12):844-848
http://www.aafp.org/afp/2013/0615/p844.pdf
Inguinal hernia is a bulge of tissue through the inguinal canal in the groin. It is more common in men, and can occur in up to a quarter of all men. Symptoms can occur gradually or suddenly. It may present as burning, gurgling or achy pain. Pain will be located at the site of the hernia and will be increased with valsalva pressure (coughing, lifting, or straining). A bulge will be palpable when the patient is standing and may disappear while lying down. During the exam, the physician should palpate into the inguinal canal while having the patient cough for bear down. If no mass is palpated, another diagnosis, such as a sports hernia, osteitis pubis, or adductor tendinopathy, should be investigated. Imaging (ultrasound, MRI) is rarely needed, but may help in discovering causes other than hernia. Female patients may also have a palpable mass, but diagnostic testing or a surgical referral may be needed to determine if a hernia is present.
Small, minimally painful hernias can just be followed. Patients need to be educated on symptoms of strangulation and incarceration. If the hernia is large and painful, referral for open repair is recommended. Post op rest should range from 10 days to month, depending on activity level
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